Soft tissue reconstruction of foot and ankle defects with reverse sural fasciocutaneous flaps / Reconstrução do tecido mole de defeitos do pé e do tornozelo com retalhos fasciocutâneos surais de fluxo reverso

ABSTRACT Objective This study presents the results of 25 consecutive patients and evaluates the success of reverse sural fasciocuteneous flap (RSFF) on coverage of the foot and ankle region. Methods A total of 25 patients with soft tissue defects in the lower leg, foot, or ankle were treated with RSFF, from January 2010 to January 2017. In the evaluation of patients, the form prepared by the clinic was used and the following data were collected: age, follow-up, gender, etiology, defect size, complications, and patient satisfaction rates. Results Mean follow up time was 18 months. In all patients, the defects were fully covered. Three patients developed partial necrosis due to venous congestion. There was no complete flap loss in any of the patients. Patient satisfaction was excellent in all cases. Conclusion RSFF is quick, versatile, and easy to apply; it also provides safe soft tissue coverage, requires no microvascular repair, and provides an alternative to microsurgical reconstruction.

RESUMO Objetivo Este estudo apresenta os resultados de 25 pacientes consecutivos e avalia o sucesso do retalho fasciocutâneo sural de fluxo reverso (RFSR) na cobertura da região do pé e tornozelo. Métodos Foram analisados 25 pacientes com defeitos de partes moles na parte inferior da perna, pé ou tornozelo com RFSR, de janeiro de 2010 a janeiro de 2017. Na avaliação dos pacientes, o formulário preparado pela clínica foi usado e os seguintes dados foram coletados: idade, seguimento, sexo, etiologia, tamanho do defeito, complicações e grau de satisfação do paciente. Resultados O tempo médio de seguimento foi de 18 meses. Em todos os pacientes os defeitos foram totalmente cobertos. Três pacientes desenvolveram necrose parcial devido à congestão venosa. Não houve perda total do retalho. O grau de satisfação dos pacientes foi excelente em todos os casos. Conclusão O retalho fasciocutâneo sural reverso é rápido, versátil e fácil de aplicar. Além disso, fornece uma cobertura de tecidos moles segura, não requer reparo microvascular e é uma opção à reconstrução microcirúrgica.

Retrograde Screw Fixation Results of Coronoid Fractures in Terrible Triad.

In this study, we aimed to evaluate the results of coronoid fracture fixation, in terrible triad of elbow injury with retrograde screws. Patients between 2008 and 2012 were reviewed. Six were men and 2 were women. Mean age was 44.5(21-62). Mean follow-up period was 25.25 months (8-50). According to Regan and Morrey classification, 6 of the fractures were Type 3 and 2 were Type 2. All cases were operated with single lateral incision. For coronoid fracture, reduction was maintained from anterior aspect and fixed with posterior percutaneous screws which were single 4.5 mm screw in 3 patients and double 3.5 mm screws in 5 patients. Mini and micro cannulated screws for 4 patients and anatomic radial head plates for 4 patients were used for radial head fractures. All lateral ligament complex repairs were performed with bone tunnel technique. The results of the treatment were evaluated with Mayo elbow performance scoring system. All the fractures were united and mean union time was 4 months (3-6). Mean active elbow flexion – extension range of motion at last visit was 108.2º (70º-130º). Mean Mayo elbow performance score of the patients was 87.5 (70-100). With retrograde screw fixation of coronoid fractures in terrible triad, we achieved a stable fixation.

A Comparison of the Essex-Lopresti Technique and Conservative Treatment for Displaced Tongue-Type Calcaneus Fractures.

Aims: This study aimed to evaluate the mid-term clinical and radiological results of conservative treatment and surgical treatment made with the Essex-Lopresti technique in tongue-type calcaneus fractures. Study Design: A comparison of two treatment options (the Essex-Lopresti Technique and conservatively). Radiological comparison, Functional comparison and isokinetic dynamometer were used to evaluate. Place and Duration of Study: 3 separate centers between November 2005 and April 2013 were examined. Methodology: A retrospective evaluation was made of 19 patients (Group 1) who were operated on with the Essex-Lopresti Technique and 27 patients (Group 2) who were treated conservatively. Radiological comparison was based on correction in Bohler’s angle. Functional comparison was made using the Maryland Foot Score (MFS). In the comparison of the gastrosoleus muscle complex strength, an isokinetic dynamometer was used. To determine the distribution of all the variables in the comparisons of the groups, the Kolmogorov-Smirnov test was used. For variables showing normal distribution, Student’s t-test (Independent Sample T Test) was applied. Results: The Maryland Foot Score was determined as 96.2 in Group 1 and 85.6 in Group 2 (p=0.002). While findings of subtalar arthrosis were determined in 2 (10.5%) patients of Group1, subtalar arthrosis was seen to have developed in 7 (25.9%) patients of Group 2 (p=0.014). In the isokinetic muscle strength measurements, the mean plantar flexion muscle strength was 106.2 (85- 122.4) Nm in Group 1 and 96.4 (73.3-124) Nm in Group 2 and this difference was statistically significant (p=0.034). Conclusion: The Essex-Lopresti Technique is an effective method in the treatment of tongue-type calcaneus fractures.